Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Apr 23;4(4):CD009537.
doi: 10.1002/14651858.CD009537.pub3.

Interventions for preventing delirium in older people in institutional long-term care

Rebecca Woodhouse  1 , Jennifer K Burton, Namrata Rana, Yan Ling Pang, Jennie E Lister, Najma Siddiqi
Affiliations
Meta-Analysis

Interventions for preventing delirium in older people in institutional long-term care

Rebecca Woodhouse et al. Cochrane Database Syst Rev. .

Abstract

Background: Delirium is a common and distressing mental disorder. It is often caused by a combination of stressor events in susceptible people, particularly older people living with frailty and dementia. Adults living in institutional long-term care (LTC) are at particularly high risk of delirium. An episode of delirium increases risks of admission to hospital, development or worsening of dementia and death. Multicomponent interventions can reduce the incidence of delirium by a third in the hospital setting. However, it is currently unclear whether interventions to prevent delirium in LTC are effective. This is an update of a Cochrane Review first published in 2014.

Objectives: To assess the effectiveness of interventions for preventing delirium in older people in institutional long-term care settings.

Search methods: We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group (CDCIG) 's Specialised Register of dementia trials (dementia.cochrane.org/our-trials-register), to 27 February 2019. The search was sufficiently sensitive to identify all studies relating to delirium. We ran additional separate searches in the Cochrane Central Register of Controlled Trials (CENTRAL), major healthcare databases, trial registers and grey literature sources to ensure that the search was comprehensive.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-randomised controlled trials (cluster-RCTs) of single and multicomponent, non-pharmacological and pharmacological interventions for preventing delirium in older people (aged 65 years and over) in permanent LTC residence.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. Primary outcomes were prevalence, incidence and severity of delirium; and mortality. Secondary outcomes included falls, hospital admissions and other adverse events; cognitive function; new diagnoses of dementia; activities of daily living; quality of life; and cost-related outcomes. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes, hazard ratios (HR) for time-to-event outcomes and mean difference (MD) for continuous outcomes. For each outcome, we assessed the overall certainty of the evidence using GRADE methods.

Main results: We included three trials with 3851 participants. All three were cluster-RCTs. Two of the trials were of complex, single-component, non-pharmacological interventions and one trial was a feasibility trial of a complex, multicomponent, non-pharmacological intervention. Risk of bias ratings were mixed across the three trials. Due to the heterogeneous nature of the interventions, we did not combine the results statistically, but produced a narrative summary.It was not possible to determine the effect of a hydration-based intervention on delirium incidence (RR 0.85, 95% confidence interval (CI) 0.18 to 4.00; 1 study, 98 participants; very low-certainty evidence downgraded for risk of bias and very serious imprecision). This study did not assess delirium prevalence, severity or mortality.The introduction of a computerised system to identify medications that may contribute to delirium risk and trigger a medication review was probably associated with a reduction in delirium incidence (12-month HR 0.42, CI 0.34 to 0.51; 1 study, 7311 participant-months; moderate-certainty evidence downgraded for risk of bias) but probably had little or no effect on mortality (HR 0.88, CI 0.66 to 1.17; 1 study, 9412 participant-months; moderate-certainty evidence downgraded for imprecision), hospital admissions (HR 0.89, CI 0.72 to 1.10; 1 study, 7599 participant-months; moderate-certainty evidence downgraded for imprecision) or falls (HR 1.03, CI 0.92 to 1.15; 1 study, 2275 participant-months; low-certainty evidence downgraded for imprecision and risk of bias). Delirium prevalence and severity were not assessed.In the enhanced educational intervention study, aimed at changing practice to address key delirium risk factors, it was not possible to determine the effect of the intervention on delirium incidence (RR 0.62, 95% CI 0.16 to 2.39; 1 study, 137 resident months; very low-certainty evidence downgraded for risk of bias and serious imprecision) or delirium prevalence (RR 0.57, 95% CI 0.15 to 2.19; 1 study, 160 participants; very low-certainty evidence downgraded for risk of bias and serious imprecision). There was probably little or no effect on mortality (RR 0.82, CI 0.50 to 1.34; 1 study, 215 participants; moderate-certainty evidence downgraded for imprecision). The intervention was probably associated with a reduction in hospital admissions (RR 0.67, CI 0.57 to 0.79; 1 study, 494 participants; moderate-certainty evidence downgraded due to indirectness).

Authors' conclusions: Our review identified limited evidence on interventions for preventing delirium in older people in LTC. A software-based intervention to identify medications that could contribute to delirium risk and trigger a pharmacist-led medication review, probably reduces incidence of delirium in older people in institutional LTC. This is based on one large RCT in the US and may not be practical in other countries or settings which do not have comparable information technology services available in care homes. In the educational intervention aimed at identifying risk factors for delirium and developing bespoke solutions within care homes, it was not possible to determine the effect of the intervention on delirium incidence, prevalence or mortality. This evidence is based on a small feasibility trial. Our review identified three ongoing trials of multicomponent delirium prevention interventions. We identified no trials of pharmacological agents. Future trials of multicomponent non-pharmacological delirium prevention interventions for older people in LTC are needed to help inform the provision of evidence-based care for this vulnerable group.

PubMed Disclaimer

Conflict of interest statement

RW: none.

JKB is an author on one of the included studies. She had no part in data extraction or assessing risk of bias for this study.

NR: none.

YLP: none.

JL: none.

NS was chief investigator for a National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) grant to investigate the effects of a delirium prevention intervention for older people in long‐term care and is an author on one of the included studies. She had no part in decisions about inclusion, data extraction, risk of bias or interpretation of findings from this study. She provided additional unpublished data on hospital admissions, at the request of RW.

Figures

1
1
Study flow diagram. CDCIG: Cochrane Dementia and Cognitive Improvement Group; LTC: long‐term care; RCT: randomised controlled trial.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Culp 2003 {published data only}
    1. Culp K, Mentes J, Wakefield B. Hydration and acute confusion in long‐term care residents. Western Journal of Nursing Research 2003;25(3):251‐66. - PubMed
Lapane 2011 {published data only}
    1. Lapane KL, Hughes CM, Daiello LA, Cameron KA, Feinberg J. Effect of a pharmacist‐led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes. Journal of the American Geriatrics Society 2011;59(7):1238‐45. - PMC - PubMed
Siddiqi 2016 {published data only}
    1. Heaven A, Cheater F, Clegg A, Collinson M, Farrin A, Forster A, et al. Pilot trial of stop delirium! (PiTStop) – a complex intervention to prevent delirium in care homes for older people: study protocol for a cluster randomised controlled trial. Trials 2014;15(47):15‐47. - PMC - PubMed
    1. Siddiqi N, Cheater F, Collinson M, Farrin A, Forster A, George D, et al. The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people. Age and Ageing 2016;45:651‐61. - PMC - PubMed

References to studies excluded from this review

Alagiakrishnan 2016 {published data only}
    1. Alagiakrishnan, K. Melatonin based therapies for delirium and dementia. Discovery Medicine 2016;21(117):363‐71. [ISSN: 1539‐6509] - PubMed
Faustino 2016 {published data only}
    1. Faustino TN, Pedreira LC, Freitas YS, Silva RM, Amaral JB. Prevention and monitoring of delirium in older adults: an educational intervention. Brazilian Journal of Nursing 2016;69(4):678‐85. - PubMed
García‐Gollarte 2014 {published data only}
    1. García‐Gollarte F, Baleriola‐Júlvez J, Ferrero‐López I, Cuenllas‐Díaz A, Cruz‐Jentoft AJ. An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription. Journal of American Medical Directors Association 2014;15(12):885‐91. - PubMed
González‐Gil 2016 {published data only}
    1. González‐Gil T. Interventions for preventing delirium in older people in institutional long‐term care. International Journal of Nursing Studies 2015;55:133‐4. - PubMed
Greendyke 1986 {published data only}
    1. Greendyke RM, Kanter DR, Schuster DB, Verstreate S, Wootton J. Propranolol treatment of assaultive patients with organic brain disease. a double‐blind crossover, placebo‐controlled study. Journal of Nervous and Mental Disease 1986;174(5):290‐4. - PubMed
Grover 2011 {published data only}
    1. Grover S, Kumar V, Chakrabarti S. Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. Journal of Psychosomatic Research 2011;71(4):277‐81. - PubMed
Hofferberth 1989 {published data only}
    1. Hofferberth B. The effect of Ginkgo biloba extract on neurophysiological and psychometric measurement results in patients with psychotic organic brain syndrome. A double‐blind study against placebo. Arzneimittel‐Forschung 1989;39(8):918‐22. - PubMed
Isaia 2009 {published data only}
    1. Isaia G, Astengo MA, Tibaldi V, Zanocchi M, Bardelli B, Obialero R, et al. Delirium in elderly home‐treated patients: a prospective study with 6‐month follow‐up. Age 2009;31(2):109‐17. - PMC - PubMed
Kim 2010 {published data only}
    1. Kim SW, Yoo JA, Lee SY, Kim SY, Bae KY, Yang SJ, et al. Risperidone versus olanzapine for the treatment of delirium. Human Psychopharmacology 2010;25(4):298‐302. - PubMed
Marcantonio 2010 {published data only}
    1. Marcantonio ER, Bergmann MA, Kiely DK, Orav EJ, Jones RN. Randomized trial of a delirium abatement program for postacute skilled nursing facilities. Journal of the American Geriatrics Society 2010;58(6):1019‐26. - PMC - PubMed
Mittal 2004 {published data only}
    1. Mittal D, Jimerson NA, Neely EP, Johnson WD, Kennedy RE, Torres RA, et al. Risperidone in the treatment of delirium: results from a prospective open‐label trial. Journal of Clinical Psychiatry 2004;65(5):662‐7. - PubMed
Moretti 2004 {published data only}
    1. Moretti R, Torre P, Antonello RM, Cattaruzza T, Cazzato G. Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: a controlled, open 24‐month study of 246 patients. American Journal of Alzheimer's Disease and Other Dementias 2004;19(6):333‐9. - PMC - PubMed
NCT03066232 {published data only}
    1. NCT03066232. Delirium in home‐dwelling old people receiving home nursing care. clinicaltrials.gov/ct2/show/record/NCT03066232 (first received 28 February 2017).
Overshott 2010 {published data only}
    1. Overshott R, Vernon M, Morris J, Burns A. Rivastigmine in the treatment of delirium in older people: a pilot study. International Psychogeriatrics 2010;22(5):812‐8. - PubMed
Pellfolk 2010 {published data only}
    1. Pellfolk TE, Gustafson Y, Bucht G, Karlsson S. Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial. Journal of the American Geriatrics Society 2010;58(1):62‐9. - PubMed
Snider 2012 {published data only}
    1. Snider KT, Snider EJ, Johnson JC, Hagan C, Schoenwald C. Preventative osteopathic manipulative treatment and the elderly nursing home resident: a pilot study. Journal of the American Osteopathic Association 2012;112(8):489‐501. - PubMed
Tahir 2010 {published data only}
    1. Tahir TA, Eeles E, Karapareddy V, Muthuvelu P, Chapple S, Phillips B, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. Journal of Psychosomatic Research 2010;69(5):485‐90. - PubMed
Ushijima 2008 {published data only}
    1. Ushijima M, Yokoyama S, Sugiyama E, Amano N. Contribution of perospirone and risperidone to reduce delirium in senile patients. Psychogeriatrics 2008;8(1):4‐7.
Yoon 2011 {published data only}
    1. Yoon HK, Kim YK, Han C, Ko YH, Lee HJ, Kwon DY, et al. Paliperidone in the treatment of delirium: results of a prospective open‐label pilot trial. Acta Neuropsychiatrica 2011;23(4):179‐83. - PubMed

References to ongoing studies

Mestres Gonzalvo 2017 {published data only}
    1. Mestres Gonzalvo C, Wit H, Oijen B, Hurkens K, Janknegt R, Schols J, et al. Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study. Biomed Central Geriatrics 2017;17(1):35. - PMC - PubMed
NCT02994979 {published data only}
    1. NCT02994979. Nursing assistant intervention to prevent delirium in nursing homes. clinicaltrials.gov/ct2/show/NCT02994979 (first received 16 December 2016).
NCT03718156 {published data only}
    1. NCT03718156. The prevention program for Alzheimer's related delirium trial (PREPARED). clinicaltrials.gov/ct2/show/NCT03718156 (first received 24 October 2018).

Additional references

Alagiakrishnan 2004
    1. Alagiakrishnan K, Wiens CA. An approach to drug‐induced delirium in the elderly. Postgraduate Medical Journal 2004;80(945):388‐93. - PMC - PubMed
APA 2013
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Vol. 5, Washington (DC): American Psychiatric Association, 2013.
Armstrong‐Esther 1996
    1. Armstrong‐Esther CA, Browne KD, Armstrong‐Esther DC, Sander L. The institutionalized elderly: dry to the bone. International Journal of Nursing Studies 1996;33(6):619‐28. - PubMed
Boockvar 2016
    1. Boockvar K, Teresi J, Inouye S. Preliminary data: an adapted hospital elder life program to prevent delirium and reduce complications of acute illness in long‐term care delivered by certified nursing assistants. Journal of the American Geriatrics Society 2016;64(5):1108‐13. [DOI: ] - PMC - PubMed
Burton 2017
    1. Burton JK, Quinn TJ, Gordon AL, MacLullich AM, Reynish E, Shenkin SD. Identifying published studies of care home research: an international survey of researchers. Journal of Nursing Home Research Sciences 2017;3:99‐102.
Burton 2018
    1. Burton JK, Guthrie B. Identifying who lives in a care home – a challenge to be conquered. Age and Ageing 2018;47(3):322‐3. [DOI: ] - PMC - PubMed
Campbell 2000
    1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D. Framework for design and evaluation of complex interventions to improve health. BMJ 2000;321:694‐6. - PMC - PubMed
Ciampi 2017
    1. Ciampi A, Bai C, Dyachenko A, McCusker J, Cole MG, Belzile E. Longitudinal patterns of delirium severity scores in long‐term care settings. International Psychogeriatrics 2017;29(1):11‐7. - PubMed
Clark 1996
    1. Clark CM, Ewbank DC. Performance of the Dementia Severity Rating Scale: a caregiver questionnaire for rating severity in Alzheimer disease. Alzheimer Disease and Associated Disorders 1996;10(1):31‐9. - PubMed
Clegg 2011
    1. Clegg A, Young J. Which medications to avoid in people at risk of delirium: a systematic review. Age and Ageing 2011;40(1):23‐9. - PubMed
Cole 2012
    1. Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, et al. The course of delirium in older long‐term care residents. International Journal of Geriatric Psychiatry 2012;27(12):1291‐7. - PubMed
Dosa 2007
    1. Dosa D, Intrator O, McNicoll L, Cang Y, Teno J. Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set. Journal of the American Geriatrics Society 2007;55(7):1099‐105. - PubMed
Fong 2015
    1. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface of delirium and dementia in older persons. Lancet Neurology 2015;14(8):823‐32. - PMC - PubMed
GRADEpro 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime, Inc.). GRADEpro GDT: GRADEpro Guideline Development Tool. McMaster University (developed by Evidence Prime, Inc.), 2015.
Higgins 2011
    1. Higgins JP, Altman DG. Chapter 8. Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hshieh 2008
    1. Hshieh TT, Fong TJ, Marcantonio ER, Inouye SK. Cholinergic deficiency hypothesis in delirium: synthesis of current evidence. Journal of Gerontology: Medical Sciences 2008;63A(7):764‐72. - PMC - PubMed
Inouye 1990
    1. Inouye SK, Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine 1990;113(12):941‐8. - PubMed
Inouye 1996
    1. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. Journal of the American Medical Association 1996;275(11):852‐7. - PubMed
Inouye 1998
    1. Inouye SK. Delirium in hospitalized older patients: recognition and risk factors. Journal of Geriatric Psychiatry and Neurology 1998;11(3):118‐25. - PubMed
Inouye 1999
    1. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo‐Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine 1999;340(9):669‐76. - PubMed
Inouye 2006
    1. Inouye SK. Delirium in older persons. New England Journal of Medicine 2006;354:1157‐65. - PubMed
Inouye 2014
    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014;383(9920):911‐22. - PMC - PubMed
Kalisvaart 2005
    1. Kalisvaart KJ, Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, et al. Haloperidol prophylaxis for elderly hip‐surgery patients at risk for delirium: a randomized placebo‐controlled study. Journal of the American Geriatrics Society 2005;53(10):1658‐66. - PubMed
Kingston 2018
    1. Kingston A, Comas‐Herrera A, Jagger C, for the MODEM project. Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study. Lancet Public Health 2018;3(9):447‐55. - PMC - PubMed
Lam 2018
    1. Lam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K, et al. Challenges of conducting research in long‐term care facilities: a systematic review. Biomed Central Geriatrics 2018;18(242):934‐9. [DOI: ] - PMC - PubMed
Leslie 2008
    1. Leslie DL, Marcantonio ER, Zhang Y, Leo‐Summers L, Inouye SK. One year health‐care costs associated with delirium in the elderly population. Archives of Internal Medicine 2008;168(1):27‐32. - PMC - PubMed
McCusker 2011
    1. McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, et al. Prevalence and incidence of delirium in long‐term care. International Journal of Geriatric Psychiatry 2011;26(11):1152‐61. - PubMed
McCusker 2013
    1. McCusker J, Cole MG, Voyer P, Vu M, Ciampi A, Monette J, et al. Environmental factors predict the severity of delirium symptoms in long‐term care residents with and without delirium. Journal of the American Geriatrics Society 2013;61(4):502‐11. - PubMed
Morichi 2018
    1. Morichi V, Fedecostante M, Morandi A, Santo SG, Mazzone A, Mossello E, et al. A point prevalence study of delirium in Italian nursing homes. Dementia and Geriatric Cognitive Disorders 2018;46(1‐2):27‐41. - PubMed
Morris 1993
    1. Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43(11):2412‐4. - PubMed
Neelon 1996
    1. Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nursing Research 1996;45(6):324‐30. - PubMed
NICE 2010
    1. National Institute for Health and Care Excellence (NICE). Delirium: diagnosis, prevention and management. NICE Clinical Guideline 103, 2010. www.nice.org.uk/nicemedia/live/13060/49909/49909.pdf (accessed 16 January 2014). - PubMed
Review Manager 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Ribbe 1997
    1. Ribbe MW, Ljunggren G, Steel K, Topinková E, Hawes C, Ikegami N, et al. Nursing homes in 10 nations: a comparison between countries and settings. Age and Ageing 1997;Suppl 2:3‐12. - PubMed
Rockwood 1999
    1. Rockwood K. Educational interventions in delirium. Dementia and Geriatric Cognitive Disorders 1999;10(5):426‐9. - PubMed
Sanford 2015
    1. Sanford AM, Orrell M, Tolson D, Abbatecola AM, Arai H, Bauer JM, et al. An international definition for "nursing home". Journal of the American Medical Directors Association 2015;16(3):181‐4. - PubMed
Siddiqi 2006
    1. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in‐patients: a systematic literature review. Age and Ageing 2006;35(4):350‐64. - PubMed
Siddiqi 2009
    1. Siddiqi N, Clegg A, Young J. Delirium in care homes. Reviews in Clinical Gerontology 2009;19:309‐16.
Siddiqi 2011
    1. Siddiqi N, Young J, House AO, Featherstone I, Hopton A, Martin C, et al. Stop delirium! A complex intervention to prevent delirium in care homes: a mixed methods feasibility study. Age and Ageing 2011;40(1):90‐8. - PubMed
Tabet 2009
    1. Tabet N, Howard R. Pharmacological treatment for the prevention of delirium: review of current evidence. International Journal of Geriatric Psychiatry 2009;24(10):1037‐44. - PubMed
Trzepacz 1988
    1. Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Research 1988;23(1):89‐97. - PubMed
Voyer 2010
    1. Voyer P, Richard S, Doucet L, Cyr N, Carmichael PH. Examination of the multifactorial model of delirium among long‐term care residents with dementia. Geriatric Nursing 2010;31(2):105‐14. - PubMed
WHO 1992
    1. World Health Organization. The ICD‐10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Vol. 10, Geneva: World Health Organization, 1992.
Witlox 2010
    1. Witlox J, Eurelings LS, Jonghe JF, Kalisvaart KJ, Gool WA. Delirium in elderly patients and the risk of post‐discharge mortality, institutionalization, and dementia. Journal of the American Medical Association 2010;304(4):443‐51. - PubMed
Yang 2009
    1. Yang FM, Marcantonio ER, Inouye SK, Kiely DK, Rudolph JL, Fearing MA, et al. Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics 2009;50(3):248‐54. - PMC - PubMed

References to other published versions of this review

Clegg 2012
    1. Clegg A, Siddiqi N, Holt R, Young J. Interventions for preventing delirium in older people in institutional long‐term care (protocol). Cochrane Database of Systematic Reviews 2012, Issue 1. [DOI: 10.1002/14651858.CD009537] - DOI - PubMed
Clegg 2014
    1. Clegg A, Siddiqi N, Heaven, A, Young J, Holt, R. Interventions for preventing delirium in older people in institutional long‐term care. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD009537.pub2] - DOI - PubMed

Publication types